In Vivo Confocal Microscopic Evaluation of Corneal Wound Healing After Femtosecond Laser-Assisted Keratoplasty

Abstract

BACKGROUND AND OBJECTIVE: To evaluate corneal wound healing after femtosecond laser-assisted keratoplasty (FLAK) using in vivo confocal microscopy (IVCM). PATIENTS AND METHODS: Prospective, interventional, consecutive case series of 17 eyes after mushroom-shaped FLAK. IVCM was performed preoperatively and at 1, 3, 6, and 12 months postoperatively to assess wound healing. RESULTS: Mean keratocyte activation grade increased from preoperative levels to 1 month postoperatively in both the central (0.41 ± 0.62 to 1.73 ± 1.03) and peripheral (0.47 ± 0.52 to 1.57 ± 1.09) cornea, then gradually decreased through 12 months. Dendritic cells increased from preoperatively to 1 month postoperatively in both the central (0.71 ± 0.83 to 1.33 ± 0.98) and peripheral (0.79 ± 0.70 to 1.42 ± 0.90) cornea, then gradually decreased until 6 months postoperatively. Stromal reinnervation was 1 month postoperatively in 8 patients (50%). By 12 months, sub-epithelial nerves were observed centrally in 5 patients (45.5%). CONCLUSION: IVCM after FLAK shows an initial increase in keratocyte activation and dendritic cells that decrease over time. Corneal reinnervation is seen as early as 1 month postoperatively.